Background: Energy balance in Obstructive Sleep Apnea (OSA), a disease closely related to obesity, is disturbed, and physical activity levels are impaired. The role of Continuous Positive Airway Pressure treatment (CPAP) in alleviating the disruptions mentioned above is questioned. The objective of this study is to explore changes in energy expenditure (EE) and physical activity (PA) in obese patients with OSA after CPAP treatment. Methods: An assessment of Basal Metabolic Rate (BMR) via indirect calorimetry (IC) was performed on 24 obese patients (male in the majority (87.5%), mean age of 52.4 ± 9.8 years), newly diagnosed with moderate–severe OSA by polysomnography, at 4-time points: at baseline, at CPAP titration, at the 1-month and the 3-month follow up. Physical activity levels were subjectively estimated using the International Questionnaire of Physical Activity (IPAQ) before and after 3 months of adherent CPAP application. Results: BMR significantly decreased after CPAP treatment (1926 ± 537.8 kcal/d at baseline, 1790 ± 493.7 kcal/d at CPAP initiation, 1680.3 ± 600.8 kcal/d at 1 month, and 1581.3 ± 478.9 kcal/d at 3 months follow up (p < 0.001)). No significant changes in IPAQ were observed over time: baseline median IPAQ: 3894 (1487.5–11,755.5) total MET·min·wk⁻¹, 3-month median IPAQ: 3900 (1512–11,824.5) total MET·min·wk⁻¹. Conclusions: CPAP has an appreciable time effect on the BMR of obese patients with moderate–severe OSA. However, this change is not accompanied by a significant increase in physical activity levels.

Background: Overlap syndrome (OS), the coexistence of chronic obstructive pulmonary disease and obstructive sleep apnea, is frequently characterized by the presence of daytime hypercapnia (pCO₂ ≥ 45 mmHg). The aim of this study was to investigate potential differences in anthropometric, sleep and respiratory characteristics between hypercapnic and normocapnic patients with OS. Methods: Consecutive patients who underwent polysomnography, pulmonary function testing and arterial blood gases and had been diagnosed with OS were enrolled in the study. Results: According to pCO₂ levels in wakefulness, the patients were divided into group A, consisting of OS patients without hypercapnia (n = 108) or group B, consisting of OS patients with hypercapnia (n = 55). The majority of included patients in both groups were males (n = 92 in group A vs. n = 50 in group B). Group B had increased BMI (p = 0.001), neck (p = 0.017) and waist circumference (p = 0.013), higher scores in Epworth sleepiness scale (ESS) (p = 0.008), increased sleep efficiency (p = 0.033), oxygen desaturation index (p = 0.004) and time with oxyhemoglobin saturation <90% (p = 0.006) than group A. Also, Group B had decreased average and minimum oxyhemoglobin saturation during sleep (p < 0.001). Hypercapnic patients had lower FEV₁% (p = 0.003), FVC% (p = 0.004), pO₂ and pCO₂ (p < 0.001 for both) values compared with normocapnic patients. In binary regression analysis, which assessed various predictors on the likelihood of having hypercapnia, it was found that BMI (OR: 1.313, 95% CI: 1.048–1.646, p = 0.018) and FVC (OR: 0.913, 95% CI: 0.845–0.986, p = 0.020) were the major determinants of hypercapnia in OS patients. Conclusions: Hypercapnic OS patients were more obese and sleepy and presented worse respiratory function in wakefulness and sleep hypoxia characteristics compared with normocapnic OS patients.

Open-circuit mouthpiece ventilation (MPV) is a method of noninvasive ventilation, which can be used to provide full-time support, induce lung volume recruitment, increase cough efficacy, defer tracheostomy and possibly improve survival and quality of life in advanced-stage neuromuscular patients. MPV might also be applicable to other chronic respiratory diseases as well as in acute exacerbations of chronic obstructive pulmonary disease and can also be employed for the extubation of unweanable neuromuscular patients. A candidate for MPV should be able to rotate his neck adequately, grab the mouthpiece with his lips and maintain sufficient control of the upper airway muscles. MPV is usually provided in the volume assisted-controlled mode with a tidal volume between 0.7 and 1.5 L, zero PEEP and backup rate set to the lower allowed value, allowing the patient to define his own ventilatory pattern. The “low pressure” and “apnea” alarm should be switched off, if possible, or special setting adjustments should be used to prevent their activation. Comprehensive patient training and dedicated nursing time are important for the application of MPV. MPV is considered a safe method for the majority of the patients, but accidental mouthpiece loss is an important concern.

Introduction: COVID-19 pandemic had a major impact on the capacity of the health care system. Chronic patients were advised to contact clinical settings only in case of emergency. The aim of our study is to evaluate whether this situation led to a neglected care pattern in Sleep Apnea Patients (SAP) and the physical and psychological consequences potentially ensuing. Method: Data was collected from the Greek Sleep Apnea Patient Cohort. A purpose built questionnaire was administered to 137 Sleep Apnea adult Patients on Positive Airway Pressure therapy at the first follow up visit after the pandemic first strict lockdown from March to May 2020. Results: We collected 137 questionnaires. Patients’ mean age was 59±11 and 64% were male. From March to May 2020, only 19% seeked medical care. 11% visited their NHS doctor and 8% private care. 41% adopted the newly introduced contactless e-prescription system in order to be able to continue the PAP therapy, avoiding their scheduled in person visit. Losing direct contact with their doctor negatively affected them emotionally (40%). Common symptoms among our population were stress (49,4%), bad mood (45,2%), insecurity (36%) and irritation (35%). 71.5 % had at least one and 39,4% more than three reported psychological symptoms. Conclusion: Covid-19 pandemic and its impact on the healthcare system definitely affected our population. A neglected care pattern is identified in Sleep Apnea Patients, clearly revealing psychological consequences. The extended use of e-prescription shows that patients are able to adopt novel types of communication with healthcare providers. The development of e-health tools may facilitate the follow up of Sleep Apnea Patients.

Obesity is frequently associated with sleep-disordered breathing (SDB) across different stages of hypoventilation. Objective: This study aimed to apply the Baveno classification system to obese patients with sleep-disordered breathing to better characterize clinical heterogeneity, investigate the distribution of hypoventilation stages within the Baveno categories, and assess its usefulness in guiding therapeutic decisions regarding ventilatory support. Methods: This is a retrospective observational study of obese patients with SDB. Patients were classified into three stages of hypoventilation based on the presence of nocturnal hypoventilation and daytime hypercapnia and were assigned to Baveno categories A–D. Clinical, polysomnographic, and laboratory data, as well as the type of ventilatory support applied, were analyzed. Results: Included were 227 patients (154 men) with a mean BMI of 42.03±8.53 kg/m², median age of 60 years, and mean AHI: 65± 32.21/h. Regarding hypoventilation severity, 40.4% of patients were classified as Stage 1, 24.0% as Stage 2, and 35.6% as Stage 3. According to the Baveno classification, the largest group was D (35.2%), followed by groups B and C, (27.3% each), and group A (10.1%). Arterial hypertension (52.9%), and diabetes mellitus (28.6%), were the most common comorbidities. The predominant ventilatory treatment was bilevel positive airway pressure (BPAP) (69.6%), followed by continuous positive airway pressure (CPAP) (30.0%). A significant association was found between the Baveno classification and the hypoventilation stage (p=0.001), as wllw as the distribution of treatment types and the Baveno category (p=0.002). Conclusions: This study suggests that the Baveno classification represents a useful multicomponent phenotyping tool in obese patients with SBD.